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Thrombolytics in pulmonary embolism

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https://www.readbyqxmd.com/read/27904506/safety-and-efficacy-of-tenecteplase-versus-alteplase-in-acute-coronary-syndrome-a-systematic-review-and-meta-analysis-of-randomized-trials
#1
REVIEW
Alexandre Guillermin, David Jun Yan, Arnaud Perrier, Christophe Marti
INTRODUCTION: Alteplase and tenecteplase are two widely used thrombolytic agents and are both approved for the treatment of acute myocardial infarction. These two molecules have increased fibrin specificity compared with older thrombolytics but distinct pharmacokinetic properties and may differ in terms of risks and benefits. We decided to review the available evidence comparing the safety and efficacy of these two molecules in acute coronary syndrome (ACS) or pulmonary embolism (PE)...
December 1, 2016: Archives of Medical Science: AMS
https://www.readbyqxmd.com/read/27899206/the-use-of-thrombolysis-for-acute-pulmonary-embolism-in-the-united-states-national-trends-and-patient-characteristics-from-2006-to-2011
#2
Barret Rush, Katie Wiskar, Landon Berger, Donald E Griesdale
BACKGROUND: Thrombolysis for the treatment of pulmonary embolism (PE) has received significant attention in the literature over the past 10 years. OBJECTIVE: Our primary objective was to examine the trend in thrombolysis use in the United States from 2006 to 2011. Secondary objectives include examining patient and hospital characteristics associated with receiving thrombolysis and rates of complications associated with thrombolysis. METHODS: In this retrospective cohort study, we used the Nationwide Inpatient Sample from 2006 to 2011 to identify patients with a diagnosis of PE who received or did not receive thrombolytic agents...
November 26, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27882375/risk-factors-for-intracranial-haemorrhage-in-patients-with-pulmonary-embolism-treated-with-thrombolytic-therapy-development-of-the-pe-ch-score
#3
Saurav Chatterjee, Ido Weinberg, Robert W Yeh, Anasua Chakraborty, Partha Sardar, Mitchell D Weinberg, Christopher Kabrhel, Geoffrey D Barnes, Debabrata Mukherjee, Dharam Kumbhani, Riyaz Bashir, Anjali Vaidya, Akaya Smith, Barry Fuchs, Peter Groeneveld, Jay Giri
Pulmonary embolism (PE) is a major cause of morbidity and mortality world-wide, and the use of thrombolytic therapy has been associated with favourable clinical outcomes in certain patient subsets. These potential benefits are counterbalanced by the risk of bleeding complications, the most devastating of which is intracranial haemorrhage (ICH). We retrospectively evaluated 9703 patients from the 2003-2012 nationwide in-patient sample database (NIS) who received thrombolytics for PE. All patients with ICH during the PE hospitalisation were identified and a clinical risk score model was developed utilizing demographics and comorbidities...
November 24, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27847100/thrombolytic-therapy-delay-is-independent-predictor-of-mortality-in-acute-pulmonary-embolism-at-emergency-service
#4
İnan Beydilli, Fevzi Yılmaz, Bedriye Müge Sönmez, Nalan Kozacı, Akar Yılmaz, İbrahim Halil Toksul, Ramazan Güven, Mustafa Avcı
Acute pulmonary embolism (PE) carries a high risk of morbidity and mortality. Delays in diagnosis or therapy may result in sudden, fatal deterioration; therefore, rapid diagnosis and an appropriate therapeutic approach are needed. We aimed to investigate the effect of delaying thrombolytic administration on the mortality rate in a suspected PE. We retrospectively analyzed 49 consecutive patients who were aged 18 years or older and received thrombolysis for a high-risk PE without a major contraindication. All patients were classified according to the time of onset of the thrombolytic therapy...
November 2016: Kaohsiung Journal of Medical Sciences
https://www.readbyqxmd.com/read/27830895/thrombolysis-for-acute-deep-vein-thrombosis
#5
REVIEW
Lorna Watson, Cathryn Broderick, Matthew P Armon
BACKGROUND: Standard treatment for deep vein thrombosis aims to reduce immediate complications. Use of thrombolysis or clot dissolving drugs could reduce the long-term complications of post-thrombotic syndrome (PTS) including pain, swelling, skin discolouration, or venous ulceration in the affected leg. This is the third update of a review first published in 2004. OBJECTIVES: To assess the effects of thrombolytic therapy and anticoagulation compared to anticoagulation alone for the management of people with acute deep vein thrombosis (DVT) of the lower limb as determined by the effects on pulmonary embolism, recurrent venous thromboembolism, major bleeding, post-thrombotic complications, venous patency and venous function...
November 10, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27790495/acute-right-heart-failure-in-a-patient-with-right-heart-thrombus-and-pulmonary-thromboembolism
#6
Mohammad Mostafa Ansari-Ramandi, Samaneh Ansari-Ramandi, Nasim Naderi
Right Heart Thrombus (RiHT) management is really controversial, and appropriate guidelines are not present for the management. In patients referring with RiHT and Pulmonary Embolism (PE), there are three ways of managing these patients. Out of the three, one is thrombectomy, which is with high risk taking in mind the comorbidities these patients have. The other is using thrombolytic which, in many cases is contraindicated or with high risk. The other less effective way is full anticoagulation. It is really controversial to choose between these ways of management and no clear approach is present...
September 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27764881/update-on-the-treatment-of-venous-thromboembolism
#7
Sam Schulman
During the past 7 years, results from phase III trials comparing nonvitamin antagonist K oral anticoagulants (NOACs) with vitamin K antagonists (VKAs) or with placebo, including 34,900 patients, have been published. Recent guidelines have been updated and now suggest treatment with NOACs rather than with VKA. Other updates in the guidelines concern the initial thrombolytic treatment for selected patients with deep vein thrombosis or pulmonary embolism as well as the possibility of withholding anticoagulation for minimal venous thromboembolism...
October 20, 2016: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/27747013/primary-pulmonary-artery-sarcoma-a-close-associate-of-pulmonary-embolism-20-year-observational-analysis
#8
Debabrata Bandyopadhyay, Tanmay S Panchabhai, Navkaranbir S Bajaj, Pradnya D Patil, Matthew C Bunte
BACKGROUND: Primary pulmonary artery sarcoma (PPAS) is a rare tumor that mimics pulmonary thromboembolism (PE). Similarities to PE can delay the diagnosis and misguide the treatment of PPAS. This study aimed to evaluate tumor characteristics and outcome predictors among those diagnosed with PPAS and misdiagnosed as PE. METHODS: From 1991-2010, 10 PPAS cases were available from the Cleveland Clinic (CC) institutional database and another 381 cases were reported in the literature...
September 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27666802/initial-experiences-with-endovascular-management-of-submassive-pulmonary-embolism-is-it-safe
#9
Timothy J Fuller, Christopher M Paprzycki, Muhammad H Zubair, Lala R Hussain, Brian A Kuhn, Matthew H Recht, Patrick E Muck
BACKGROUND: Interventional strategies for massive and submassive Pulmonary Embolism (smPE) have historically included either systematic intravenous thrombolytic alteplase (IV TPA) or surgical embolectomy, both of which are associated with significant morbidity and mortality. However, with the advent of endovascular techniques, recent studies have suggested that an endovascular approach to the treatment of acute smPE may be both safe and effective with excellent outcomes. The purpose of this study was to evaluate the outcomes of patients who have undergone catheter directed thrombolysis (CDT) for smPE at our institution in an effort to determine the safety of the procedure...
September 22, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27628004/thrombolytic-therapy-by-tissue-plasminogen-activator-for-pulmonary-embolism
#10
Md Shahidul Islam
Clinicians need to make decisions about the use of thrombolytic (fibrinolytic) therapy for pulmonary embolism (PE) after carefully considering the risks of major complications from bleeding, and the benefits of treatment, for each individual patient. They should probably not use systemic thrombolysis for PE patients with normal blood pressure. Treatment by human recombinant tissue plasminogen activator (rt-PA), alteplase, saves the lives of high-risk PE patients, that is, those with hypotension or in shock...
September 15, 2016: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/27620307/surgical-treatment-of-acute-massive-pulmonary-embolism
#11
Ziv Beckerman, Gil Bolotin
Massive pulmonary embolism (MPE) is a life-threatening condition. The management of MPE has changed over the course of the last few years. Since the emergence of thrombolytic therapy, only a few patients remain amenable for surgical treatment. Currently, surgical embolectomy is advised only in very specific indications. This chapter will review the background, history, indications, surgical technique and results of surgical pulmonary embolectomy in patients with MPE.
September 13, 2016: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/27601482/clot-extraction-with-the-flowtriever-device-in-acute-massive-pulmonary-embolism
#12
Aaron Samuel Weinberg, Suhail Dohad, Danny Ramzy, Hooman Madyoon, Victor F Tapson
Clinical guidelines support the use of systemic thrombolytic therapy for acute massive pulmonary embolism (PE). When anticoagulation and thrombolysis fail or are contraindicated, options become limited. We report an acute PE case in which treatment options were limited, and a novel device, the FlowTriever (Inari Medical, Irvine, California), was successfully used. This is the first case report of the use of this device that we are aware of.
September 6, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27566503/pulmonary-embolism-with-right-ventricular-dysfunction-who-should-receive-thrombolytic-agents
#13
Hem Desai, Bhupinder Natt, Christian Bime, Joshua Dill, James E Dalen, Joseph S Alpert
BACKGROUND: Appropriate management of pulmonary embolism patients with right ventricular dysfunction is uncertain. Recent guidelines have stressed the need for more data on the use of thrombolytic agents in the stable pulmonary embolism patient with right ventricular dysfunction. The objective of this study is to investigate the hypothesis that thrombolytic therapy in hemodynamically stable pulmonary embolism patients with right ventricular dysfunction is not associated with improved mortality...
August 24, 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27513332/anti-vascular-endothelial-growth-factor-antibody-suppresses-erk-and-nf-%C3%AE%C2%BAb-activation-in-ischemia-reperfusion-lung-injury
#14
Chou-Chin Lan, Chung-Kan Peng, Shih-En Tang, Shu-Yu Wu, Kun-Lun Huang, Chin-Pyng Wu
Ischemia-reperfusion (IR)-induced acute lung injury (ALI) is implicated in several clinical conditions like lung transplantation, acute pulmonary embolism after thrombolytic therapy, re-expansion of collapsed lung from pneumothorax or pleural effusion, cardiopulmonary bypass and etc. Because mortality remains high despite advanced medical care, prevention and treatment are important clinical issues for IR-induced ALI. Vascular endothelial growth factor (VEGF) has a controversial role in ALI. We therefore conducted this study to determine the effects of anti-VEGF antibody in IR-induced ALI...
2016: PloS One
https://www.readbyqxmd.com/read/27510333/practical-echocardiographic-approach-for-risk-stratification-of-patients-with-acute-pulmonary-embolism
#15
Qaiser Shafiq, George V Moukarbel, Rajesh Gupta, Dawn-Alita Hernandez, Samer J Khouri
Acute pulmonary embolism remains a common cause of mortality. Early diagnosis and appropriate risk stratification is necessary to individualize treatment strategy. Computed tomography scan of the pulmonary arteries is routinely used to diagnose acute pulmonary embolism and in some cases is useful to assess right ventricular dilation. In patients with acute pulmonary embolism, right ventricular dilation and dysfunction indicates a high-risk situation where immediate administration of thrombolytic agent, catheter-directed thrombolysis, or surgical embolectomy could be considered...
August 10, 2016: Journal of Echocardiography
https://www.readbyqxmd.com/read/27422214/pulseless-electrical-activity-in-pulmonary-embolism-treated-with-thrombolysis-from-the-peapett-study
#16
Mohsen Sharifi, Jeremy Berger, Paul Beeston, Curt Bay, Zoltan Vajo, Seyed Javadpoor
OBJECTIVE: Pulseless electrical activity (PEA) during cardiac arrest portends a poor prognosis. There is a paucity of data in the use of thrombolytic therapy in PEA and cardiopulmonary arrest due to confirmed pulmonary embolism (PE). We evaluated the outcome of low-dose systemic thrombolysis with tissue plasminogen activator (tPA) in patients presenting with PEA due to PE. METHODS: During a 34-month period, we treated 23 patients with PEA and cardiopulmonary arrest due to confirmed massive PE...
June 30, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27397618/endovascular-management-of-budd-chiari-syndrome-with-inferior-vena-cava-thrombosis-a-14-year-single-center-retrospective-report-of-55-patients
#17
Xiangchen Meng, Yong Lv, Bojing Zhang, Chuangye He, Wengang Guo, Bohan Luo, Zhanxin Yin, Daiming Fan, Guohong Han
PURPOSE: To evaluate safety and efficacy of balloon dilation and stent placement combined with thrombus aspiration and thrombolysis to treat patients with Budd-Chiari syndrome (BCS) with inferior vena cava (IVC) thrombosis. MATERIALS AND METHODS: Charts from 55 consecutive patients with primary BCS and IVC thrombosis treated between April 2000 and August 2014 were retrospectively analyzed. Transcatheter aspiration and percutaneous recanalization were attempted in all patients, and stents were placed if balloon dilation was successful...
October 2016: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/27394395/right-atrial-thrombus-and-massive-pulmonary-embolism-refractory-to-thrombolytic-therapy-a-case-report
#18
Simon De Freitas, Caoilfhionn Connolly
INTRODUCTION: Unsuccessful thrombolysis in the setting of massive pulmonary embolism confers poor prognosis and the optimal management strategy is unknown. Options include re-thrombolysis and embolectomy. PRESENTATION OF CASE: A 32-year-old lady presented with massive pulmonary embolism accompanied by an intermittently-obstructive right atrial thrombus. Failure to improve with thrombolytic therapy prompted transfer to our cardiothoracic unit for emergency surgical embolectomy...
2016: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/27376230/bomb-blast-and-its-consequences-successful-intensive-care-management-of-massive-pulmonary-embolsim
#19
Faisal Shamim, Muhammad Rizwan, Adil Aziz
A suicide bomb blast in 2013 at a distant city of Pakistan killed 84 and wounded more than 150 people. Some patients were transferred to our tertiary care hospital because of extreme load on medical services there. This patient arrived at the Aga Khan Hospital, 2 days after the bomb blast injury and underwent an orthopedic procedure. Next day, he developed sudden tachypnea, desaturation, and circulatory collapse. After initial cardiopulmonary resuscitation, he was immediately transferred to surgical intensive care unit...
June 2016: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
https://www.readbyqxmd.com/read/27365074/-venous-thromboembolism-during-the-cisplatin-based-adjuvant-chemotherapy-report-of-a-case
#20
Eiji Yamada, Takashi Yoshioka, Masahiko Muro
We report a case of venous thromboembolism during the cisplatin-based adjuvant chemotherapy. A 49-year-old woman who was undergone left lower lobectomy for the lung cancer received adjuvant chemotherapy of cisplatin + vinorelbine ditartrate regimen. On day 11 after starting the chemotherapy, she presented a left lower leg pain and readmitted. Computed tomography revealed a deep venous thrombosis of the left lower leg and peripheral pulmonary embolism. The symptom and thromboembolism were successfully treated by anticoagulant drug and thrombolytic therapy...
July 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
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